iMedPub Journals ht tp://wwwimedpub.com ARCHIVES OF MEDICINE 2015 Vol. 7 No. 4:10 1 © Copyright iMedPub | This article is available from: www.archivesofmedicine.com Lipedema Fat and Signs and Symptoms of Illness, Increase with Advancing Stage Karen L. Herbst 1 , Liza Mirkovskaya 1 , Aditi Bharhagava 1 , Yamini Chava 1 Charisse Hanne T. Te 2 1 Department of Medicine, University of California, San Diego, CA, USA 2 Department of Medicine, University of Arizona, Tucson, AZ, USA Corresponding Author: Karen L. Herbst Department of Medicine, Division of Endocrinology, University of Arizona, 3950 South Country Club Drive, Suite 200, Room 2221, Tucson, Arizona, USA  karenherbst@deptofmed.arizona.edu Tel: 5206266797 Abstract Background: Lipedema is a poorly known disorder of painful subcutaneous adi- pose tssue (SAT) likely afectng millions of women worldwide. Stage 1 lipedema has smooth skin with increased underlying fat, Stage 2 has indentatons and nod- ules, and Stage 3 has large extrusions of skin and SAT. Women with lipedema have more SAT below the waist. As this gynoid fat is known to be cardioprotectve, we aimed to determine if health declined with increasing stage and extent of lipede- ma SAT. Methods and Findings: Chart review from June 2012 to February 2013 at a ter- tary academic center. Fify women and one man were included in consecutve order. Fat was assessed in 29 areas for lipomas, size of the depot, and presence of lipedema fat. Pain was assessed by a numerical pain scale. Average age of patents was 50 ± 13 y; average body mass index was 38 ± 12 kg/m 2 . Median age of devel- opment of lipedema was 20 y. Pain occurred daily in 89.7%. None of the patents with Stage 1 lipedema had diabetes, hypertension or dyslipidemia. The amount of lipedema fat difered signifcantly between Stages of lipedema (p=0.003), with Stage 3 having signifcantly more. There was no diference in fat depot size or number of lipomas amongst Stages. Only one of 51 patents had type 2 diabetes. There was an increase in shortness of breath, palpitatons, urinaton, and numb- ness in Stage 3. Conclusions: Lipedema fat can develop in any SAT locaton and increases in asso- ciaton with increasing signs and symptoms of systemic illness. Keywords: Lipedema, lipoedema, lymphedema, lipolymphedema, spheroids Introducton Lipedema (lipoedema in Europe) meaning fuid or swelling in fat is a painful disorder involving subcutaneous adipose tssue (SAT). Lipedema was frst named in the literature in 1940 by Drs. Allen and Hines as a conditon occurring almost exclusively in women who sufer from enlargement of fat tssue of the lower extremites and butocks [1]; older literature also contains descriptons of women with lipedema [2,3]. In more recent literature, lipedema is described as a bilateral conditon that does not afect the hands or feet [4] with a disproporton between a smaller upper body and a “voluminous” lower body [5]. There are three stages of lipedema that refer primarily to changes in the skin [6,7]: Stage 1 in which there is a normal skin surface with enlarged hypodermal SAT; Stage 2 with indentatons of the skin and underlying SAT similar to a matress [8] containing larger mounds of SAT that grow as non-encapsulated masses, lipomas and angiolipomas; Stage 3 where large extrusions of tssue (skin and SAT) cause gross deformatons especially on the thighs and around the knees. Lymphedema, where lymph fuid develops dependently on the feet and hands increasing cranially due to dysfunctonal lymphatcs, can develop during any stage of lipedema, and is called lipolymphedema or Stage 4 lipedema. Lipedema therefore is a pre-lymphedema conditon; though not everyone with lipedema will go on to develop lymphedema. The authors found in clinical practce that lipedema fat tssue was found more extensively on the body than is currently described in the literature. In additon, women with stage 3 lipedema appeared to have greater and more serious complaints than women with earlier stages of lipedema. The goal of this report was to gain a greater understanding of the extent of lipedema tssue on the body in all stages, and to determine if a later stage